Robotic catheter system including imaging system control

ABSTRACT

A robotic catheter procedure system includes a bedside system and a workstation. The bedside system includes an actuating mechanism configured to engage and to impart movement to a percutaneous device. The workstation includes a user interface and a control system configured to be operatively coupled to the user interface, the bedside system, and a medical imaging system. The control system is responsive to a first input and to a second input, and the user interface receives the second input from a user. The control system is configured to generate a first control signal to the medical imaging system based on the first input, and the medical imaging system captures at least one image in response to the first control signal. The control system is configured to generate a second control signal to the actuating mechanism based on the second input, and the actuating mechanism causes movement of the percutaneous device in response to the second control signal. The first input is indicative of upcoming percutaneous device movement.

CROSS-REFERENCE TO RELATED PATENT APPLICATION

This application is a continuation to U.S. application Ser. No.13/833,874, filed Mar. 15, 2013, which is a continuation-in-part toApplication No. PCT/US12/30068, filed Mar. 22, 2012, which claims thebenefit of U.S. Provisional Application No. 61/466,399, filed Mar. 22,2011, all of which are incorporated herein by reference in theirentireties.

BACKGROUND OF THE INVENTION

The present invention relates generally to the field of catheter systemsfor performing diagnostic and/or intervention procedures. The presentinvention relates specifically to catheter systems and methodsincorporating control of a medical imaging system.

Vascular disease, and in particular cardiovascular disease, may betreated in a variety of ways. Surgery, such as cardiac bypass surgery,is one method for treating cardiovascular disease. However, undercertain circumstances, vascular disease may be treated with a catheterbased intervention procedure, such as angioplasty. Catheter basedintervention procedures are generally considered less invasive thanstandard surgery. If a patient shows symptoms indicative ofcardiovascular disease, an image of the patient's heart may be taken toaid in the diagnosis of the patient's disease and to determine anappropriate course of treatment. For certain disease types, such asatherosclerosis, the image of the patient's heart may show a lesion thatis blocking one or more coronary arteries. Following the diagnosticprocedure, the patient may undergo a catheter based interventionprocedure. During one type of intervention procedure, a catheter isinserted into the patient's femoral artery and moved through thepatient's arterial system until the catheter reaches the site of thelesion. In some procedures, the catheter is equipped with a balloon or astent that when deployed at the site of a lesion allows for increasedblood flow through the portion of the coronary artery that is affectedby the lesion. During certain procedures, an image of the patient'sheart or vasculature is captured during the procedure to aid in thepositioning of the catheter in to appropriate position for treatment. Inaddition to cardiovascular disease, other diseases (e.g., hypertension,etc.) may be treated using catheterization procedures.

SUMMARY OF THE INVENTION

In accordance with an embodiment, a robotic catheter procedure systemconfigured to be operated in conjunction with a medical imaging systemincludes a bedside system comprising an actuating mechanism configuredto engage and to impart movement to a percutaneous device and aworkstation that includes a user interface configured to receive a firstinput and a second input, the first input indicating an upcomingpercutaneous device movement and the second input received from a user,a sensor configured to detect the presence of the user's hand adjacentthe user interface, wherein the first input is generated by the sensor,and a control system coupled to the user interface, the bedside systemand the medical imaging system, the control system responsive to thefirst input and the second input and programmed to generate a firstcontrol signal based on the first input and transmit the first controlsignal to the medical imaging system, wherein the first control signalcauses the medical imaging system to capture at least one image, andgenerate a second control signal based on the second input and transmitthe second control signal to the bedside system, wherein the actuatingmechanism causes movement of the percutaneous device in response to thesecond control signal, wherein the control system generates the secondcontrol signal following generation of the first control signal.

In accordance with another embodiment, a method for operating a roboticcatheter procedure system and a medical imaging system includesproviding a percutaneous device, providing an actuating mechanismconfigured to engage and to impart movement to the percutaneous device,receiving a first input indicative of upcoming percutaneous devicemovement, wherein the first input is received from a sensor configuredto detect the presence of the user's hand adjacent a user interface,triggering capture of images by the medical imaging system in responseto the first input, receiving a second input wherein the second input isreceived from a control, and moving the percutaneous device with theactuating mechanism in response to the second input, wherein moving thepercutaneous device occurs after triggering the capture of images

Alternative exemplary embodiments relate to other features andcombinations of features as may be generally recited in the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

This application will become more fully understood from the followingdetailed description, taken in conjunction with the accompanyingfigures, wherein like reference numerals refer to like elements inwhich:

FIG. 1 is a perspective view of a catheter procedure system according toan exemplary embodiment;

FIG. 2 is a block diagram of a catheter procedure system according to anexemplary embodiment;

FIG. 3 is a block diagram of a catheter procedure system depicting abedside system, an imaging system and a contrast injection systemaccording to an exemplary embodiment;

FIG. 4 is a block diagram of a controller for controlling a roboticcatheter system according to an exemplary embodiment;

FIG. 5 is a perspective view of controls for a robotic catheter systemaccording to an exemplary embodiment;

FIG. 6 is a flow diagram showing control of an imaging system and apercutaneous device according to an exemplary embodiment;

FIG. 7A is an enlarged perspective view of a control for a roboticcatheter system in a resting position according to an exemplaryembodiment;

FIG. 7B is an enlarged perspective view of a control for a roboticcatheter system in a first actuated position according to an exemplaryembodiment;

FIG. 7C is an enlarged perspective view of a control for a roboticcatheter system in a second actuated position according an to exemplaryembodiment; and

FIG. 8 is a flow diagram showing control of a contrast injection device,an imaging system and a percutaneous device according to an exemplaryembodiment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Before turning to the figures, which illustrate the exemplaryembodiments in detail, it should be understood that the presentapplication is not limited to the details or methodology set forth inthe description or illustrated in the figures. It should also beunderstood that the terminology is for the purpose of description onlyand should not be regarded as limiting.

Referring to FIG. 1, a catheter procedure system 10 is shown. Catheterprocedure system 10 may be used to perform catheter based medicalprocedures (e.g., percutaneous intervention procedures). Percutaneousintervention procedures may include diagnostic catheterizationprocedures during which one or more catheters are used to aid in thediagnosis of a patient's disease. For example, during one embodiment ofa catheter based diagnostic procedure, a contrast media is injected intoone or more coronary arteries through a catheter and an image of thepatient's heart is taken. Percutaneous intervention procedures may alsoinclude catheter based therapeutic procedures (e.g., balloonangioplasty, stent placement, treatment of peripheral vascular disease,etc.) during which a catheter is used to treat a disease. It should benoted, however, that one skilled in the art would recognize that certainspecific percutaneous intervention devices or components (e.g., type ofguide wire, type of catheter, etc.) will be selected based on the typeof procedure that is to be preformed. Catheter procedure system 10 iscapable of performing any number of catheter based medical procedureswith minor adjustments to accommodate the specific percutaneous devicesto be used in the procedure. In particular, while the embodiments ofcatheter procedure system 10 described herein are explained primarily inrelation to the diagnosis and/or treatment of coronary disease, catheterprocedure system 10 may be used to diagnose and/or treat any type ofdisease or condition amenable to diagnosis and/or treatment via acatheter based procedure.

Catheter procedure system 10 includes lab unit 11 and workstation 14.Catheter procedure system 10 includes a robotic catheter system, such asbedside system 12, located within lab unit 11 adjacent patient 21.Generally, bedside system 12 may be equipped with the appropriatepercutaneous devices (e.g., guide wires, guide catheters, workingcatheters, catheter balloons, stents, diagnostic catheters, etc.) orother components (e.g., contrast media, medicine, etc.) to allow theuser to perform a catheter based medical procedure. A robotic cathetersystem, such as bedside system 12, may be any system configured to allowa user to perform a catheter based medical procedure via a roboticsystem by operating various controls such as the controls located atworkstation 14. Bedside system 12 may include any number and/orcombination of components to provide bedside system 12 with thefunctionality described herein. Bedside system 12 may include a cassette56 coupled to a base 19, and cassette 56 may include a housing 22 thatsupports the various components of the cassette. Various embodiments ofbedside system 12 and cassette 56 are described in detail in P.C.T.International Application No. PCT/US2009/042720, filed May 4, 2009,which is incorporated herein by reference in its entirety.

In one embodiment, bedside system 12 may be equipped to perform acatheter based diagnostic procedure. In this embodiment, bedside system12 may be equipped with one or more of a variety of catheters for thedelivery of contrast media to the coronary arteries. In one embodiment,bedside system 12 may be equipped with a first catheter shaped todeliver contrast media to the coronary arteries on the left side of theheart, a second catheter shaped to deliver contrast media to thecoronary arteries on the right side of the heart, and a third cathetershaped to deliver contrast media into the chambers of the heart.

In another embodiment, bedside system 12 may be equipped to perform acatheter based therapeutic procedure. In various embodiments, catheterprocedure system 10 may be equipped with a guide catheter, a guide wire,and a working catheter (e.g., a balloon catheter, a stent deliverycatheter, an ablation catheter, etc.). During certain therapeuticprocedures an expandable percutaneous device (e.g., an angioplastyballoon, stent, etc.) may be positioned near one end of the workingcatheter. The working catheter is navigated through a patient's vascularsystem to position the expandable percutaneous device at a portion of ablood vessel that has been narrowed due to a lesion caused by a disease,such as atherosclerosis. The expandable percutaneous device is expandedat the narrowed portion to increase the diameter of the blood vessellumen at the lesion. This expansion allows for increased blood flowthrough that portion of the blood vessel. In the case of balloonangioplasty, the expandable device is an angioplasty balloon that isexpanded by being inflated to compress the material of the lesion whichincreases the diameter of the blood vessel. In the case of stentplacement, a stent is expanded and left inside the blood vessel at thesite of a lesion to increase the diameter of the blood vessel. In onestent placement technique, a balloon (e.g., a balloon configured todeploy a stent) is positioned in the middle of the stent, and theexpansion of the balloon expands the stent.

Bedside system 12 may be equipped with a variety of catheter types asneeded for a particular procedure or based on the preference of thedoctor performing the procedure. In one embodiment, bedside system 12may be equipped with a working catheter that includes a secondary lumenthat is threaded over the guide wire during a procedure. In anotherembodiment, bedside system 12 may be equipped with an over-the-wireworking catheter that includes a central lumen that is threaded over theguide wire during a procedure. In another embodiment, bedside system 12may be equipped with an intravascular ultrasound (IVUS) catheter. Inanother embodiment, any of the percutaneous devices of bedside system 12may be equipped with positional sensors that indicate the position ofthe component within the body.

Bedside system 12 is in communication with workstation 14, allowingsignals generated by the user inputs and control system of workstation14 to be transmitted to the various devices/systems located within labunit 11 (e.g., bedside system 12, imaging system 32, contrast injectionsystem 13, etc.) to control the operation of the variousdevices/systems. Bedside system 12 and/or imaging system 32 also mayprovide feedback signals (e.g., operating conditions, warning signals,error codes, etc.) to workstation 14. Bedside system 12 may be connectedto workstation 14 via a communication link 38 that may be a wirelessconnection, cable connectors, or any other means capable of allowingcommunication to occur between workstation 14 and beside system 12.

Workstation 14 includes a user interface 30 configured to receive userinputs to operate various components or systems of catheter proceduresystem 10. User interface 30 includes controls 16. Controls 16 allow theuser to control bedside system 12 to perform a catheter based medicalprocedure. For example, controls 16 may be configured to cause bedsidesystem 12 to perform various tasks using the various percutaneousdevices with which bedside system 12 may be equipped (e.g., to advance,retract, or rotate a guide wire, advance, retract, or rotate a workingcatheter, advance, retract, or rotate a guide catheter, inflate ordeflate a balloon located on a catheter, position and/or deploy a stent,inject contrast media into a catheter, inject medicine into a catheter,or to perform any other function that may be performed as part of acatheter based medical procedure, etc.). In some embodiments, one ormore of the percutaneous intervention devices may be steerable, andcontrols 16 may be configured to allow a user to steer one or moresteerable percutaneous device. In one such embodiment, bedside system 12may be equipped with a steerable guide catheter, and controls 16 mayalso be configured to allow the user located at remote workstation 14 tocontrol the bending of the distal tip of a steerable guide catheter. Inaddition, controls 16 may be configured to allow a user located atworkstation 14 to control operation of imaging system 32.

In one embodiment, controls 16 include a touch screen 18, a dedicatedguide catheter control 29, a dedicated guide wire control 23, and adedicated working catheter control 25. In this embodiment, guide wirecontrol 23 is a joystick configured to advance, retract, or rotate aguide wire, working catheter control 25 is a joystick configured toadvance, retract, or rotate a working catheter, and guide cathetercontrol 29 is a joystick configured to advance, retract, or rotate aguide catheter. In addition, touch screen 18 may display one or moreicons (such as icons 162, 164, and 166) that control movement of one ormore percutaneous devices via bedside system 12. Controls 16 may alsoinclude a balloon or stent control that is configured to inflate ordeflate a balloon and/or a stent. Each of the controls may include oneor more buttons, joysticks, touch screens, etc., that may be desirableto control the particular component to which the control is dedicated.

Controls 16 may include an emergency stop button 31 and a multiplierbutton 33. When emergency stop button 31 is pushed a relay is triggeredto cut the power supply to bedside system 12. Multiplier button 33 actsto increase or decrease the speed at which the associated component ismoved in response to a manipulation of guide catheter control 29, guidewire control 23, and working catheter control 25. For example, ifoperation of guide wire control 23 advances the guide wire at a rate of1 mm/sec, pushing multiplier button 33 may cause the operation of guidewire control 23 to advance the guide wire at a rate of 2 mm/sec.Multiplier button 33 may be a toggle allowing the multiplier effect tobe toggled on and off. In another embodiment, multiplier button 33 mustbe held down by the user to increase the speed of a component duringoperation of controls 16.

User interface 30 may include a first monitor 26 and a second monitor28. First monitor 26 and second monitor 28 may be configured to displayinformation or patient-specific data to the user located at workstation14. For example, first monitor 26 and second monitor 28 may beconfigured to display image data (e.g., x-ray images, MRI images, CTimages, ultrasound images, etc.), hemodynamic data (e.g., bloodpressure, heart rate, etc.), patient record information (e.g., medicalhistory, age, weight, etc.). In one embodiment, monitors 26 and/or 28may be configured to display an image of a portion of the patient (e.g.,the patient's heart) at one or more magnification levels. In addition,first monitor 26 and second monitor 28 may be configured to displayprocedure specific information (e.g., duration of procedure, catheter orguide wire position, volume of medicine or contrast agent delivered,etc.). Monitor 26 and monitor 28 may be configured to displayinformation regarding the position and/or bend of the distal tip of asteerable guide catheter. Further, monitor 26 and monitor 28 may beconfigured to display information to provide the functionalitiesassociated with the various modules of controller 40 discussed below. Inanother embodiment, user interface 30 includes a single screen ofsufficient size to display one or more of the display components and/ortouch screen components discussed herein.

Catheter procedure system 10 also includes an imaging system 32 locatedwithin lab unit 11. Imaging system 32 may be any medical imaging systemthat may be used in conjunction with a catheter based medical procedure(e.g., angiogram system, non-digital x-ray, digital x-ray, CT, MRI,ultrasound, etc.). In an exemplary embodiment, imaging system 32 is adigital x-ray imaging device that is in communication with workstation14. Referring to FIG. 1, imaging system 32 may include a C-arm thatallows imaging system 32 to partially or completely rotate aroundpatient 21 in order to obtain images at different angular positionsrelative to patient 21 (e.g., sagital views, caudal views, cranio-caudalviews, etc.).

Imaging system 32 is configured to take x-ray images of the appropriatearea of patient 21 during a particular procedure. For example, imagingsystem 32 may be configured to take one or more x-ray images of theheart to diagnose a heart condition. Imaging system 32 may also beconfigured to take one or more x-ray images during a catheter basedmedical procedure (e.g., real-time images) to assist the user ofworkstation 14 to properly position a guide wire, guide catheter,working catheter, stent, etc. during the procedure. The image or imagesmay be displayed on first monitor 26 and/or second monitor 28.

Referring to FIG. 2, a block diagram of catheter procedure system 10 isshown according to an exemplary embodiment. Catheter procedure system 10may include a control system, such as controller 40. Controller 40 maybe part of workstation 14. Controller 40 is in communication with one ormore bedside systems 12, controls 16, monitors 26 and 28, imaging system32, and patient sensors 35 (e.g., electrocardiogram (“ECG”) devices,electroencephalogram (“EEG”) devices, blood pressure monitors,temperature monitors, heart rate monitors, respiratory monitors, etc.).In addition, controller 40 may be in communication with a hospital datamanagement system or hospital network 34, one or more additional outputdevices 36 (e.g., printer, disk drive, cd/dvd writer, etc.), and ahospital inventory management system 37. Controller 40 may also be incommunication with a contrast injection system 13, a drug injectionsystem 15 and an ablation system 17.

Communication between the various components of catheter proceduresystem 10 may be accomplished via communication links 38. Communicationlinks 38 may be dedicated wires or wireless connections. Communicationlinks 38 may also represent communication over a network. Catheterprocedure system 10 may be connected or configured to include any othersystems and/or devices not explicitly shown. For example, catheterprocedure system 10 may include IVUS systems, image processing engines,data storage and archive systems, automatic balloon and/or stentinflation systems, medicine tracking and/or logging systems, user logs,encryption systems, systems to restrict access or use of catheterprocedure system 10, robotic catheter systems of the past, present, orfuture, etc.

Referring to FIG. 3, a block diagram of catheter procedure system 10 isshown according to an exemplary embodiment. Catheter procedure system 10may include various actuating mechanisms that engage and impart motionto an associated percutaneous device in response to a user'smanipulation of controls 16 and/or under control of controller 40. Inone embodiment, catheter procedure system 10 includes a guide wireactuating mechanism 50, a working catheter actuating mechanism 52, and aguide catheter actuating mechanism 54. In other embodiments, catheterprocedure system 10 may include an actuating mechanism for inflating anangioplasty or stent delivery balloon. In one embodiment, guide wireactuating mechanism 50 and working catheter actuating mechanism 52 areincorporated within cassette 56. Additional embodiments of bedsidesystem 12 and cassette 56 are described in detail in P.C.T.International Application No. PCT/US2009/042720, filed May 4, 2009,which is incorporated herein by reference in its entirety.

Guide wire actuating mechanism 50 is coupled to guide wire 58 such thatguide wire actuating mechanism 50 is able to cause guide wire 58 toadvance, retract, and rotate. Working catheter actuating mechanism 52 iscoupled to working catheter 60 such that working catheter actuatingmechanism 52 is able to cause working catheter 60 to advance, retract,and rotate. Connector 62 couples guide catheter 64 to guide catheteractuating mechanism 54 such that guide catheter actuating mechanism 54is able to cause guide catheter 64 to advance, retract, and rotate. Invarious embodiments, guide wire actuating mechanism 50, working catheteractuating mechanism 52, and guide catheter actuating mechanism 54 mayeach include an engagement structure suitable for engaging therespective percutaneous device such that the actuating mechanism is ableto impart axial and/or rotational movement to the percutaneous device.

A Y-connector 66 is coupled to guide catheter actuating mechanism 54 viaconnector 68. In various embodiments, connector 68 may be a componentseparate from both Y-connector 66 and guide catheter actuating mechanism54. In other embodiments, connector 68 may be part of (e.g., integralwith) Y-connector 66 or part of actuating mechanism 54. In oneembodiment, Y-connector 66 is also connected to cassette 56.

In one embodiment, Y-connector 66 includes a first leg, a second leg,and a third leg. The first leg of the Y-connector is connected to or incommunication with the internal lumen of guide catheter 64. The secondleg is angled away from the longitudinal axis of guide catheter 64. Thesecond leg provides a port for the injection of fluids (e.g., contrastmedia, medicine, etc.) into the lumen of guide catheter 64. As shown inFIG. 3, contrast injection system 13 is coupled to the second leg ofY-connector 66 via a conduit 65 that allows contrast media to bedelivered from contrast injection system 13 to Y-connector 66. The thirdleg of Y-connector 66 is coupled to a cassette 56 and receives bothguide wire 58 and working catheter 60. Thus, by this arrangement, guidewire 58 and working catheter 60 are inserted through Y-connector 66 intothe internal lumen of guide catheter 64.

Guide wire actuating mechanism 50 includes a rotate actuator 70 and anadvance/retract actuator 72. Rotate actuator 70 is configured to causerotation of guide wire 58 about its longitudinal axis. Advance/retractactuator 72 is configured to advance and/or retract guide wire 58 (i.e.,to advance and/or retract along the longitudinal axis of the guide wire)within patient 21. Working catheter actuating mechanism 52 includes arotate actuator 74 and an advance/retract actuator 76. Rotate actuator74 is configured to cause rotation of working catheter 60 about itslongitudinal axis. Advance/retract actuator 76 is configured to advanceand/or retract working catheter 60 (i.e., to advance and/or retractalong the longitudinal axis of the working catheter) within patient 21.Guide catheter actuating mechanism 54 includes a rotate actuator 78, anadvance/retract actuator 80, and a bend actuator 82. Rotate actuator 78is configured to cause rotation of guide catheter 64 about itslongitudinal axis. Advance/retract actuator 80 is configured to advanceand/or retract guide catheter 64 (i.e., to advance and/or retract alongthe longitudinal axis of the guide catheter) within patient 21. In someembodiments, guide catheter 64 may include one or more bend controlelements that allow the user to cause bending of the distal tip of guidecatheter 64. In such an embodiment, bend actuator 82 causes the distaltip of guide catheter 64 to bend in response to the user's manipulationof controls 16.

Referring to the block diagram of FIG. 3, controls 16 and controller 40located at workstation 14 are communicably coupled to various portionsof bedside system 12 to allow the user to control movement of guide wire58, working catheter 60 and guide catheter 64 and any other percutaneousdevices that bedside system 12 is equipped with. Controls 16 andcontroller 40 are communicably coupled to guide catheter actuatingmechanism 54 to allow the user to move guide catheter 64. In addition,controls 16 are communicably coupled to cassette 56 to allow the user tocontrol guide wire 58 via guide wire actuating mechanism 50 and tocontrol working catheter 60 via working catheter actuating mechanism 52.In various embodiments, controller 40 may be configured to provideautomated movement of a percutaneous device.

In one embodiment, cassette 56 is configured to be coupled to a motordrive base 19 (shown in FIG. 1). In this embodiment, each of theactuators 70, 72, 74, and 76 of cassette 56 are configured to engagecapstans extending from the motor drive base. Motors located within themotor drive base drive (e.g., rotate) the capstans, which in turn drivethe actuators 70, 72, 74, and 76 of cassette 56. When the actuators 70,72, 74, and 76 of cassette 56 are engaged with guide wire 58 and workingcatheter 60, respectively, the actuators 70, 72, 74, and 76 of cassette56 transfer the rotational movement of the capstans to cause themovement of guide wire 58 and working catheter 60. In anotherembodiment, the motors that drive the capstans of the motor drive basemay be located outside of the base connected to cassette 56 via anappropriate transmission device (e.g., shaft, cable, etc.). In yetanother embodiment, cassette 56 includes motors located within cassette56 associated with the actuators 70, 72, 74, and 76, and cassette 56 ismounted to a base providing a power supply (e.g., battery, AC buildingpower supply, etc.) to the motors within cassette 56.

Catheter procedure system 10 is also configured to provide control ofimaging system 32 and contrast injection system 13 via controls 16and/or controller 40. As shown in FIG. 3, controls 16 and controller 40are located at workstation 14 and are communicably coupled to imagingsystem 32 and to contrast injection system 13 to allow the user tocontrol imaging system 32 and contrast injection system 13 fromworkstation 14. As explained in more detail below, catheter proceduresystem 10 is configured such that control of imaging system 32 and/orcontrast injection system 13 is integrated with control of bedsidesystem 12 to provide for convenient, efficient and intuitive controlover both systems by a user located at workstation 14. In variousembodiments, various functions of imaging system 32 (e.g., imagecapture, magnification, collimation, c-arm positioning, etc.) may becontrolled via controls 16 and/or controller 40. For example, controls16 may be configured to allow the user positioned at workstation 14 todirectly control operation of imaging system 32 via interaction withcontrols 16 that specifically operate imaging system 32 (e.g., viainteraction with an imaging start button, an image system “on-off”button, an image system touch screen icon, a user entered text commandto start imaging, selection of an imaging activation element from a dropdown menu, etc.). In addition, catheter procedure system 10 may beconfigured to provide for automatic, intelligent or semi-automaticcontrol of imaging system 32 via controller 40 (e.g., without requiringthe user to interact with a control specific to the imaging system).

In one embodiment, the user of workstation 14 may be able to control theangular position of imaging system 32 relative to the patient to obtainand display various views of the patient's heart on first monitor 26and/or second monitor 28 via operation of controls 16. In anotherembodiment, controller 40 may automatically control the angular positionof imaging system 32 according to a particular module or set ofinstructions. Displaying different views at different portions of theprocedure may aid the user of workstation 14 to properly move andposition the percutaneous devices within the 3D geometry of thepatient's heart. For example, displaying the proper view during aprocedure may allow the user to view a patient's vascular system fromthe proper angle to ensure that the distal tip of a steerable guidecatheter is bent in the proper way to ensure the catheter is moved asintended. In an exemplary embodiment, imaging system 32 may be any 3Dimaging modality of the past, present, or future, such as an x-ray basedcomputed tomography (CT) imaging device, a magnetic resonance imagingdevice, a 3D ultrasound imaging device, etc. In this embodiment, theimage of the patient's heart that is displayed during a procedure may bea 3D image.

Referring to FIG. 4, a block diagram of a control system, such ascontroller 40, is shown according to an exemplary embodiment. Controller40 generally may be an electronic control unit suitable to providecatheter procedure system 10 with the various functionalities describedherein. For example, controller 40 may be an embedded system, adedicated circuit, a general purpose system programmed with thefunctionality described herein, etc. Controller 40 includes a processingcircuit 90, memory 92, communication module or subsystem 94,communication interface 96, procedure control module or subsystem 98,simulation module or subsystem 100, assist control module or subsystem102, mode selection module or subsystem 104, inventory module orsubsystem 106, GUI module or subsystem 108, data storage module orsubsystem 110, and record module or subsystem 112. In one embodiment,controller 40 may include a movement instruction module that includesone or more instruction sets that dictate how bedside system 12 respondsto a user's manipulation of controls 16 to cause a percutaneous deviceto move in a particular way. The movement instruction module may includevarious instruction sets to facilitate traversal of a vascular occlusionby the percutaneous devices as discussed herein. Various embodiments ofa catheter procedure system 10 including a movement instruction moduleare disclosed in P.C.T. International Application No. PCT/US2010/52178,filed Oct. 11, 2010, which is incorporated herein by reference in itsentirety.

Processing circuit 90 may be a general purpose processor, an applicationspecific processor (ASIC), a circuit containing one or more processingcomponents, a group of distributed processing components, a group ofdistributed computers configured for processing, etc., configuredprovide the functionality of module or subsystem components 94, 98-112.Memory 92 (e.g., memory unit, memory device, storage device, etc.) maybe one or more devices for storing data and/or computer code forcompleting and/or facilitating the various processes described in thepresent disclosure. Memory 92 may include volatile memory and/ornon-volatile memory. Memory 92 may include database components, objectcode components, script components, and/or any other type of informationstructure for supporting the various activities described in the presentdisclosure.

According to an exemplary embodiment, any distributed and/or localmemory device of the past, present, or future may be utilized with thesystems and methods of this disclosure. According to an exemplaryembodiment, memory 92 is communicably connected to processing circuit 90and module components 94, 98-112 (e.g., via a circuit or any otherwired, wireless, or network connection) and includes computer code forexecuting one or more processes described herein. A single memory unitmay include a variety of individual memory devices, chips, disks, and/orother storage structures or systems.

Module or subsystem components 94, 98-112 may be computer code (e.g.,object code, program code, compiled code, script code, executable code,non-transitory programmed instructions, or any combination thereof),hardware, software, or any combination thereof, for conducting eachmodule's respective functions. Module components 94, 98-112 may bestored in memory 92, or in one or more local, distributed, and/or remotememory units configured to be in communication with processing circuit90 or another suitable processing system.

Communication interface 96 includes one or more component forcommunicably coupling controller 40 to the other components of catheterprocedure system 10 via communication links 38. Communication interface96 may include one or more jacks or other hardware for physicallycoupling communication links 38 to controller 40, an analog to digitalconverter, a digital to analog converter, signal processing circuitry,and/or other suitable components. Communication interface 96 may includehardware configured to connect controller 40 with the other componentsof catheter procedure system 10 via wireless connections. Communicationmodule 94 is configured to support the communication activities ofcontroller 40 (e.g., negotiating connections, communication via standardor proprietary protocols, etc.).

Data storage module 110 is configured to support the storage andretrieval of information by controller 40. In one embodiment, datastorage module 110 is a database for storing patient specific data,including image data. In another embodiment, data storage module 110 maybe located on hospital network 34. Data storage module 110 and/orcommunication module 94 may also be configured to import and/or exportpatient specific data from hospital network 34 for use by controller 40.Controller 40 includes a GUI module 108 the controls the display ofvarious information on the display devices (e.g., monitors 26 and 28,touch screen 18, etc.) of workstation 14. In one embodiment, GUI module108 is configured to display image data captured by imaging system 32during a procedure to assist the user of catheter procedure system 10perform a procedure.

Controller 40 also includes a procedure control module 98 configured tosupport the control of various devices/systems located within lab unit11 (e.g., bedside system 12, imaging system 32, contrast injectionsystem 13, etc.) by a user located at workstation 14 during a catheterbased medical procedure. In various embodiments, procedure controlmodule 98 allows the user to operate bedside system 12, imaging system32, and/or contrast injection system 13 by manipulating controls 16. Insuch embodiments, procedure control module 98 is configured to generateone or more control signals 116 based upon the user's manipulation ofcontrols 16 and/or based upon other data, modules, instruction sets,etc. available to procedure control module 98. Control signals 116 mayalso be generated by controller 40 to provide for automatic (e.g.,control signals not based on user operation of controls 16) orsemi-automatic (e.g., control signals partially based on user operationof controls 16) control of bedside system 12, imaging system 32,contrast injection system 13, etc.

Referring back to FIG. 3, control signals 116 generated by procedurecontrol module 98 are communicated from controller 40 to the variousactuators of bedside system 12, to imaging system 32, to contrastinjection system 13, and to any other device or system controlled bycontroller 40. Referring to bedside system 12, in response to controlsignals 116, the actuators of cassette 56 cause movement of the guidewire, working catheter and/or guide catheter. Thus, in this manner, theactuators of bedside system 12 cause movement of the percutaneousdevices in response to user inputs received by controls 16 and based onother data or control schemes discussed herein. In addition, variousfunctions of imaging system 32 (e.g., image capture, magnification,collimation, c-arm positioning, etc.) are controlled in response tocontrol signals 116, and injection of contrast media into the patient bycontrast injection system 13 is controlled in response to controlsignals 116.

Procedure control module 98 may also cause data appropriate for aparticular procedure to be displayed on monitors 26 and 28. Procedurecontrol module 98 may also cause various icons (e.g., icons 162, 164,166, etc.) to be displayed on touch screen 18 that the user may interactwith to control the use of bedside system 12.

Referring to FIG. 5, an enlarged view of controls 16 are shown accordingto an exemplary embodiment. As shown in FIG. 5, controls 23, 25 and 29are joystick controls that, when actuated by the user, cause procedurecontrol module 98 to generate one or more control signals 116 which inturn cause bedside system 12 to move (e.g., advance, retract, rotate,etc.) the guide wire, working catheter and guide catheter, respectively.In this embodiment, the movement rate of a percutaneous device caused bybedside system 12 is a function of or is proportional to the degree ofdisplacement of the joystick from the resting position and the directionof movement is a function of the direction of joystick displacement.

As noted above, catheter procedure system 10 may be configured such thatcontrol of imaging system 32 and contrast injection system 13 areintegrated with control of bedside system 12 to provide for convenient,efficient and intuitive control over both systems by a user located atworkstation 14. In particular, catheter procedure system 10 may beconfigured to automatically activate image capture by imaging system 32immediately prior to percutaneous device movement, to maintain imagecapture during percutaneous device movement and to automatically ceaseimage capture following percutaneous device movement.

FIG. 6 is a flow-diagram depicting a process of automatic image captureintegrated with control of a robotic catheter system according to anexemplary embodiment. The process shown in FIG. 6 may be performed by acontroller 40 including a module (e.g., procedure control module 98)that is configured to provide this functionality.

At step 170, controller 40 of catheter procedure system 10 receives aninput indicative of upcoming percutaneous device movement. For example,the input received at step 170 may indicate that the user located atworkstation 14 intends to move a percutaneous device with bedside system12 by interacting with controls 16. At step 172, procedure controlmodule 98 automatically generate a control signal 116 based upon theinput received at step 170. The control signal generated at step 172 arecommunicated to imaging system 32, and imaging system 32 is responsiveto these control signals to trigger capture of images. The imagescaptured in response to these control signals are captured prior tomovement of the percutaneous device. At step 174, the captured imagesare displayed to the user located at workstation 14 via a display, suchas monitors 26 and 28.

At step 176, procedure control module 98 generates one or more controlsignals 116 that are communicated to one or more actuator of bedsidesystem 12 (in addition to the control signals causing image capture) tocause movement of the percutaneous device in accordance with the user'smanipulation of controls 16. At step 178, procedure control module 98determines whether the user is still operating controls 16 to causemovement of the percutaneous device. If the user is still operatingcontrols 16, then at step 180 procedure control module 98 continues togenerate control signals to capture images via imaging system 32, todisplay images on monitors 26 and 28 and to cause movement of thepercutaneous device via bedside system 12. In this manner, imagescaptured by image system 32 are displayed immediately prior topercutaneous device movement and continuously during percutaneous devicemovement.

If the user has stopped operating controls 16, then at step 182 bothimage capture and percutaneous device movement are stopped. Thus, inthis embodiment, procedure control module 98 is configured to controlboth image capture and percutaneous device movement in an intuitivemanner via user interaction with a single control associated with thepercutaneous device. This eliminates the need for the user toindependently and separately actuate a separate control (e.g., adedicated imaging system activation button) to trigger image captureprior to percutaneous device movement.

In one embodiment, procedure control module 98 is configured tocontinuously cause the display of the last image captured by imagingsystem 32 on monitors 26 or 28 after device movement has stopped. Inthis embodiment, the user located at workstation 14 can easily view thelast captured image as the user decides the next action to take duringthe procedure.

FIGS. 7A-7C show a catheter procedure system 10 configured to receive aninput indicative of upcoming percutaneous device movement. Controller 40(e.g., via instructions of procedure control module 98) is configuredsuch that image capture via imaging system 32 is triggered when the userfirst begins to interact with one of the input devices or controls ofcontrols 16 but prior to triggering movement of the percutaneous devicein response to the user's interaction with the input device.

Referring to FIG. 7A, a control, for example working catheter joystick25, is shown in the resting position (e.g., the non-actuated position,prior to movement of the control by the user). Working catheter control25 may include an activation zone 184 surrounding control 25 such thatcontrol 25 is located within activation zone 184 when the control is inthe resting position. With the control in the resting position,controller 40 does not generate control signals to either imaging system32 or bedside system 12.

Referring to FIG. 7B, control 25 is shown displaced from the restingposition but still within activation zone 184, and in this embodiment,this position of control 25 generates the input indicative of upcomingpercutaneous device movement that is received at step 170 in FIG. 6.When the control 25 has been displaced from the resting position but isstill within activation zone 184 as shown in FIG. 7B, procedure controlmodule 98 is configured to generates one or more control signals 116 toinstruct imaging system 32 to begin image capture but does not generatecontrol signals 116 to the actuators of bedside system 12. Thus, in thisembodiment, activation zone 184 is the zone in which control 25 may beactuated from the resting position such that image capture is triggeredbut device movement is not yet started.

Referring to FIG. 7C, control 25 is shown displaced such that thecontrol has moved outside of activation zone 184. Once control 25 hasbeen actuated out of activation zone 184, as shown in FIG. 7C, procedurecontrol module 98 is configured to generate a control signal 116 that iscommunicated to an actuator of bedside system 12 to cause movement ofthe percutaneous device in accordance with the movement of the control25. In this embodiment, when control 25 is in the position shown in FIG.7C, procedure control module 98 is configured to continue to generatethe control signals that cause capture of images at the same time as itis generating the control signals that cause movement of thepercutaneous device. In this manner, image capture and display continuesto occur as the percutaneous device is being moved by the user. Thus, inthis embodiment, the input that triggers image capture and the inputthat triggers movement of the percutaneous device are received from auser by a single control. Lastly, procedure control module 98 isconfigured to stop generation of both the control signals to imagingsystem 32 and to bedside system 12 when control 25 is returned to theresting position of FIG. 7A.

As discussed above regarding FIGS. 7A-7C, activation zone 184 is agraphical representation of the amount of displacement of control 25that is necessary to generate control signals to imaging system 32 andto bedside system 12 (i.e., the size of activation zone 184). The sizeof activation zone 184 may be determined by the configuration ofprocedure control module 98. For example, procedure control module 98may include computer code or instructions that dictate how muchdisplacement of the control is necessary to generate the differentcontrol signals. In various embodiments, procedure control module 98will be configured such that size of activation zone 184 is fairly small(e.g., less than 1 mm, less than 5 mm, less than 10 mm, etc.) to ensurethat control 25 does not need to be moved a large distance in order totrigger movement of the percutaneous device.

The embodiment shown in FIGS. 7A-7C utilizes the amount of displacementof a percutaneous device control as the input that indicates upcomingpercutaneous device movement and that automatically triggers imagecapture prior to percutaneous device movement. In other embodiments,other mechanisms may be used. For example, procedure control module 98may be configured such that once working catheter control 25 is actuatedby the user, image capture by imaging system 32 is triggered andmovement of the percutaneous device in response to the user operation ofcontrol 25 is delayed until image acquisition and display has started.In this embodiment, the input indicative of upcoming percutaneous devicemovement is the input received by controller 40 that is generated byactuation of control 25. In this embodiment, the input that triggersimage capture is initial interaction with control 25 by the user, andcontroller 40 generates the control signal to bedside system 12 to causemovement of the percutaneous device after a predetermined time followinggeneration of the control signal to the imaging system.

In another embodiment, controller 40 may receive feedback signals fromimaging system 32 or from the display components indicating that imageacquisition and display has started. Once image acquisition has startedand the image is displayed, procedure control module 98 then generatescontrol signals to bedside system 12 to cause movement of thepercutaneous device in accordance with the user's manipulation of thecontrol. In one such embodiment, controller 40 may be configured togenerate the control signal to bedside system 12 to cause movement ofthe percutaneous device only after the imaging system has begun imagecapture.

In other embodiments, the input indicative of the user's intent to movea percutaneous device may be generated by devices other than one of thepercutaneous device controls of workstation 14. In one such embodiment,workstation 14 may include one or more sensors 186 (shown in FIG. 5)configured to detect the presence of a user's hand approaching one ofthe percutaneous device controls (e.g., controls 23, 25, 29) of controls16. The sensors may be a one or more of a variety of different proximitysensors (e.g., infrared sensors, optical sensors, capacitive sensors,reflective sensors, etc.) mounted to the housing of controls 16 andadjacent to the individual input device of controls 16 that the sensoris associated with. In this embodiment, activation zone 184 isestablished by the proximity sensor, and upcoming percutaneous devicemovement is indicated by the proximity sensor when the user's hand isdetected within the activation zone. The proximity sensor transmits a“presence” signal to controller 40 when the proximity sensor detects thepresence of a user's hand adjacent the control, and, based upon thisinput from the proximity sensor, controller 40 generates one or morecontrol signal 116 to trigger image capture by imaging system 32.

Following the start of image acquisition, movement of the percutaneousdevice is then triggered as the user continues to actuate the control(e.g., working catheter control 25). In one such embodiment, procedurecontrol module 98 may be configured to stop image capture andpercutaneous device movement when the control is returned to the restingposition. In another embodiment, procedure control module 98 may beconfigured to stop percutaneous device movement when the control isreturned to the resting position and to stop image acquisition when theproximity sensor indicates that the user's hand has exited activationzone 184.

In another embodiment instead of receiving an input indicative ofupcoming movement from a physical input device, controller 40 mayinclude a prediction module that is configured (e.g., programmed) withan algorithm that predicts when the next movement of a percutaneousdevice is likely to be initiated based on identified patterns of use ofthe various controls. In this embodiment, the prediction module providesthe input indicative of upcoming device movement to procedure controlmodule 98, and procedure control module 98 then triggers image captureprior to the predicted time of movement initiation. For example, if thecontrol use pattern indicates that working catheter control 25 istypically actuated after a certain time period (e.g., 10 seconds)following operation of guide wire control 23, procedure control module98 may be configured to trigger image capture via imaging system 32immediately before the time period expires following operation of guidewire control 23.

In another embodiment, the input indicative of upcoming percutaneousdevice movement is not an input generated by a dedicated or specificimaging system control (e.g., via interaction with an imaging startbutton, an image system on button, an image system touch screen icon, auser entered text command to start imaging, selection of an imagingactivation element from a drop down menu, etc.). In one such embodiment,controls 16 may include a dedicated or specific imaging system controlto allow the user to directly control imaging system 32 independent fromthe automatic or semi-automatic control that is based on the inputindicative of upcoming device movement.

It should be understood that while only working catheter joystick 25 isshown in FIGS. 7A-7C, any control (e.g., guide wire control 23, guidecatheter control 29, touch screen icons 162, 164, 166, etc.) located atworkstation 14 may include various activation zones as discussed above.

As shown in FIG. 3, controller 40 may be in communication with contrastinjection system 13. Various embodiments of a catheter procedure systemincluding a contrast media injection system are described in detail inP.C.T. International Application No. PCT/US2009/067540, filed Dec. 10,2009, which is incorporated herein by reference in its entirety. Inembodiments where catheter procedure system is equipped with a contrastinjection system 13, catheter procedure system 10 may be configured toautomatically trigger injection of contrast media via contrast injectionsystem 13 prior to percutaneous device movement and prior to automaticimage capture to ensure sufficient contrast media is present within apatient's vasculature during image capture. In such embodiments,controller 40 is configured to generate one or more control signal 116to contrast injection system 13 based upon an input indicative ofupcoming percutaneous device movement. FIG. 8 is a flow-diagramdepicting a process of automatic contrast media injection and automaticimage capture integrated with control of a robotic catheter systemaccording to an exemplary embodiment. The process shown in FIG. 8 may beperformed by a controller 40 including a module (e.g., procedure controlmodule 98) that is configured to provide this functionality.

At step 190, catheter procedure system 10 receives an input indicatingthat the user located at workstation 14 intends to move a percutaneousdevice with bedside system 12 by interacting with controls 16. Any ofthe inputs indicating upcoming device movement discussed above may bereceived at step 190. At step 192, procedure control module 98automatically generates control signals 116 based upon the inputreceived at step 190, and the generated control signals 116 arecommunicated to contrast injection system 13 to trigger injection ofcontrast media prior to both image capture and movement of thepercutaneous device. At step 194, procedure control module 98automatically generates control signals 116 based upon the inputreceived at step 190, and the generated control signals 116 arecommunicated to imaging system 32 to trigger image capture by imagingsystem 32 prior to movement of the percutaneous device but afterinjection of contrast media at step 192. At step 196, the capturedimages are displayed to the user located at workstation 14 via adisplay, such as monitors 26 and 28.

At step 198, procedure control module 98 generates one or more controlsignals 116 that are communicated to one or more actuator of bedsidesystem 12 (in addition to the control signals causing image capture andcontrast injection) to cause movement of the percutaneous device inaccordance with the user's manipulation of controls 16. At step 200,procedure control module 98 determines whether the user is stilloperating controls 16 to cause movement of the percutaneous device. Ifthe user is still operating controls 16, then at step 202 procedurecontrol module 98 continues to generate control signals to periodicallyinject contrast media via contrast injection system 13, to captureimages via imaging system 32, to display the captured images and tocause movement of the percutaneous device via bedside system 12. In thismanner, images captured by image system 32 are displayed immediatelyprior to percutaneous device movement and continuously duringpercutaneous device movement.

If the user has stopped operating controls 16, then at step 204,contrast injection, image capture and percutaneous device movement arestopped when the user stops manipulating controls 16. Thus, in thisembodiment, procedure control module 98 is configured to controlcontrast injection, image capture and percutaneous device movement in anintuitive manner via interaction by the user with a single controlassociated with the percutaneous device. This eliminates the need forthe user to independently and separately actuate a separate control totrigger contrast media injection or image capture prior to percutaneousdevice movement.

In another embodiment the medical imaging system interacts with therobotic catheter procedure system and a targeting system to limit thex-rays from the imaging system to the immediate vicinity of a selectedportion of the percutaneous device as it moves within the patientthereby reducing the x-ray exposure of the patient from that typicalwithout such targeting. The targeting system may be instructed where toallow the x-rays to hit in any of a number of ways. The user mayinstruct the targeting system by using the display provided by themedical imaging system The targeting system may system may allow thex-rays to hit only the immediate vicinity of the leading edge of thepercutaneous device controlled by the bedside system of the roboticcatheter procedure system by recognizing the leading edge in the imageprovided by the medical imaging system. The targeting system may allowthe x-rays to hit only the immediate vicinity of the leading edge of thepercutaneous device controlled by the bedside system of the roboticcatheter procedure system in response to a signal emitted by the leadingedge. Or the targeting system may allow the x-rays to hit only theimmediate vicinity of the leading edge of the percutaneous devicecontrolled by the bedside system of the robotic catheter proceduresystem in response to information provided to it by the bedside system.

The medical imaging system may initially provide a display of theselected portion of the percutaneous device within or about to enter thepatient along with a display of other portions of the patient such asthe path the device is expected to follow as it accomplishes itsdiagnostic or therapeutic goal. The user may then interact with thisdisplay to instruct the targeting system narrow the beam of incidentx-rays of the medical imaging system to the immediate vicinity of theselected portion. The display may allow the user to zoom in on the imageof the selected portion and this zooming action may then be used toinstruct the targeting system. The user may interact with the displayusing an input device such as a mouse of a light pencil. The display maybe presented on a touch screen and the user may direct the targetingsystem by touching the appropriate portion of the image on the touchscreen. The user may repeatedly interact with the display to track theprogress of the leading edge as it advances into the patient.

The targeting system may be configured or trained to recognize theleading edge of the percutaneous device and upon recognizing it in animage provided by the medical imaging system it may act to allow theincident X-rays of this system to hit only the immediate vicinity of theleading edge. The targeting system may be preloaded with images ofleading edges which are likely to be encountered in the operation of arobotic catheter procedure system such as the leading end of a guide orworking catheter or a guide wire. Or the targeting system may beequipped with a module that allows it to be trained by the user. In thiscase the user would direct the targeting system to recognize theparticular leading edge appearing in a given image.

The targeting system may be instructed as to the location of the leadingedge of the percutaneous device by the bedside system of the roboticcatheter procedure system. The bedside system may have one or moresensors which detect the distance that it has advanced or retracted thepercutaneous device into or out of the patient. For instance, if thedevice is a guide or working catheter or a guide wire the bedside systemmay have a sensor which detects the distance forward into the patient orthe distance backward out of the patient it has moved the catheter orguide wire.

The targeting system may be instructed as to the location of the leadingedge of the percutaneous device by a signal emanating from this leadingedge. The leading edge may be associated with a radio frequency (RF) tagwhich is probed by the targeting system. In this case an RF generatorand an RF detector would be part of the targeting system. The leadingedge may emit radiation of a particular frequency which isdistinguishable from the X-rays of the medical imaging system. Or theleading edge may emit a magnetic signal. For instance, it may have beenmagnetized.

The medical imaging system may be a fluoroscopic system that comprisesan X-ray emitter spatially separated from an X-ray detector such thatthe patient is placed between them. For instance it may have the C armstructure 32 illustrated in FIG. 1. The targeting system may direct themovement of the emitter, the detector or both to cause the X-rays to belimited to the immediate vicinity of a selected portion of theprecutaneous device. Alternatively the patient 21 may be on a moveablesupport whose motion is directed by the targeting system. In such a casethe bedside 12 would be attached to the moveable support to preserve itsorientation to the patient 21 when the targeting system causes thesupport to move. The targeting system may also direct both the C arm andthe support to move in order to cause the X-rays to be limited to theimmediate vicinity of a selected portion of the precutaneous device. Theemitter of the fluoroscopic system may have a shutter which limits thebeam of radiation traveling between the emitter and the detector inresponse to instructions from the targeting system. This shutter may beadjustable so that it limits the beam to different portions of thepatient as instructed by the targeting system. Such an adjustableshutter is described in U.S. Published Patent Application 2011/0075805which is incorporated herein by reference.

The targeting system facilitates the operation of the bedside system 12illustrated in FIG. 1 while reducing the X-ray exposure of the patient21. The procedure involves advancing the percutaneous device into thepatient with the robotic catheter procedure system, displaying thelocation of the percutaneous device within the patient on the display 26or 28 and limiting the x-rays from the emitter of the medical imagingsystem 32 to the immediate vicinity of the leading edge of thepercutaneous device as it moves within the patient. In one embodimentthe display is a touch screen visible to the user of the roboticcatheter procedure system, the imaging system displays a substantialportion of the path the percutaneous device is expected to follow as itadvances into the patient and the user interacts with the touch screento limit the x-rays to immediate vicinity of the leading edge of thepercutaneous device as the device advances into the patient.

Further modifications and alternative embodiments of various aspectswill be apparent to those skilled in the art in view of thisdescription. Accordingly, this description is to be construed asillustrative only. The construction and arrangements, shown in thevarious exemplary embodiments, are illustrative only. While the currentapplication recites particular combinations of features in the claimsappended hereto, various embodiments of the invention relate to anycombination of any of the features described herein whether or not suchcombination is currently claimed, and any such combination of featuresmay be claimed in this or future applications. Any of the features,elements, or components of any of the exemplary embodiments discussedabove may be used alone or in combination with any of the features,elements, or components of any of the other embodiments discussed above.Although only a few embodiments have been described in detail in thisdisclosure, many modifications are possible (e.g., variations in sizes,dimensions, structures, shapes and proportions of the various elements,values of parameters, mounting arrangements, use of materials, colors,orientations, etc.) without materially departing from the novelteachings and advantages of the subject matter described herein. Someelements shown as integrally formed may be constructed of multiple partsor elements, the position of elements may be reversed or otherwisevaried, and the nature or number of discrete elements or positions maybe altered or varied. The order or sequence of any process, logicalalgorithm, or method steps may be varied or re-sequenced according toalternative embodiments. Other substitutions, modifications, changes andomissions may also be made in the design, operating conditions andarrangement of the various exemplary embodiments without departing fromthe scope of the present invention.

What is claimed is:
 1. A robotic catheter procedure system configured tobe operated in conjunction with a medical imaging system comprising: abedside system comprising an actuating mechanism configured to engageand to impart movement to a percutaneous device; and a workstation, theworkstation comprising: a user interface configured to receive a firstinput and a second input, the first input indicating an upcomingpercutaneous device movement and the second input received from a user;a sensor configured to detect the presence of the user's hand adjacentthe user interface, wherein the first input is generated by the sensor;and a control system coupled to the user interface, the bedside systemand the medical imaging system, the control system responsive to thefirst input and the second input and programmed to: generate a firstcontrol signal based on the first input and transmit the first controlsignal to the medical imaging system, wherein the first control signalcauses the medical imaging system to capture at least one image; andgenerate a second control signal based on the second input and transmitthe second control signal to the bedside system, wherein the actuatingmechanism causes movement of the percutaneous device in response to thesecond control signal; wherein the control system generates the secondcontrol signal following generation of the first control signal.
 2. Arobotic catheter procedure system according to claim 1, wherein thefirst input is an input received by the user interface from a user.
 3. Arobotic catheter procedure system according to claim 2, wherein the userinterface includes a control and the control is configured to receiveboth the first input and the second input.
 4. A robotic catheterprocedure system according to claim 3, wherein the control is ajoystick.
 5. A robotic catheter procedure system according to claim 4,wherein the first input is a first displacement of the joystick and thesecond input is a second displacement of the joystick.
 6. A roboticcatheter procedure system according to claim 5, wherein the firstdisplacement is less than the second displacement.
 7. A robotic catheterprocedure system according to claim 1, wherein the percutaneous deviceis selected from the group consisting of a guide wire, a workingcatheter, and a guide catheter.
 8. A robotic catheter procedure systemaccording to claim 1, wherein the control system is configured togenerate the first control signal before the second control signal suchthat the medical imaging system begins to capture images prior tomovement of the percutaneous device.
 9. A robotic catheter proceduresystem according to claim 1, wherein the sensor is a proximity sensor.10. A robotic catheter procedure system according to claim 1, whereinthe first input and the second input are received from a user by asingle control and further wherein the control system is programmed togenerate the second control signal after the medical imaging system hasbegun image capture.
 11. A robotic catheter procedure system accordingto claim 1, further comprising a contrast media injection system,wherein the control system generates a third control signal andtransmits the third control signal to the contrast media injectionsystem based on the first input, wherein the contrast media injectionsystem delivers contrast media into a patient in response to the thirdcontrol signal.
 12. A robotic catheter procedure system according toclaim 11, wherein the control system generates the third control signalprior to the first control signal such that the contrast media isdelivered to the patient prior to beginning of image capture.
 13. Amethod for operating a robotic catheter procedure system and a medicalimaging system comprising: providing a percutaneous device; providing anactuating mechanism configured to engage and to impart movement to thepercutaneous device; receiving a first input indicative of upcomingpercutaneous device movement, wherein the first input is received from asensor configured to detect the presence of the user's hand adjacent auser interface; triggering capture of images by the medical imagingsystem in response to the first input; receiving a second input whereinthe second input is received from a control; and moving the percutaneousdevice with the actuating mechanism in response to the second input;wherein moving the percutaneous device occurs after triggering thecapture of images.
 14. A method according to claim 13, wherein the firstinput and the second input are received from a user by a control.
 15. Amethod according to claim 13, further comprising triggering injection ofcontrast media in response to the first input.
 16. A method according toclaim 13, wherein the triggering of the injection of contrast mediaoccurs before the triggering the capture of images and the triggering ofimage capture occurs before the movement of the percutaneous device. 17.A robotic catheter procedure system configured to be operated inconjunction with a medical imaging system comprising: a bedside systemcomprising an actuating mechanism configured to engage and to impartmovement to a percutaneous device; and a workstation, the workstationcomprising: a user interface configured to receive a first input and asecond input, the first input indicating an upcoming percutaneous devicemovement and the second input received from a user; a sensor configuredto detect the presence of the user's hand adjacent the user interface,wherein the first input is generated by the sensor; and a control systemcoupled to the user interface, the bedside system and the medicalimaging system, the control system responsive to the first input and thesecond input and programmed to: generate a first control signal based onthe first input and transmit the first control signal to the medicalimaging system, wherein the first control signal causes the medicalimaging system to capture at least one image; and generate a secondcontrol signal based on the second input and transmit the second controlsignal to the bedside system, wherein the actuating mechanism causesmovement of the percutaneous device in response to the second controlsignal; wherein the control system receives a feedback signal from themedical imaging system and the control system generates the secondcontrol signal in response to the feedback signal from the medicalimaging system.
 18. A robotic catheter procedure system according toclaim 17, wherein the feedback signal indicates that image acquisitionhas begun.
 19. A robotic catheter procedure system configured to beoperated in conjunction with a medical imaging system comprising: abedside system comprising an actuating mechanism configured to engageand to impart movement to a percutaneous device; and a workstation, theworkstation comprising: a user interface configured to receive a firstinput and a second input, the first input indicating an upcomingpercutaneous device movement and the second input received from a user;a display configured to receive and display at least one image from themedical imaging system; a sensor configured to detect the presence ofthe user's hand adjacent the user interface, wherein the first input isgenerated by the sensor; and a control system coupled to the userinterface, the bedside system, the display and the medical imagingsystem, the control system responsive to the first input and the secondinput and programmed to: generate a first control signal based on thefirst input and transmit the first control signal to the medical imagingsystem, wherein the first control signal causes the medical imagingsystem to capture at least one image; and generate a second controlsignal based on the second input and transmit the second control signalto the bedside system, wherein the actuating mechanism causes movementof the percutaneous device in response to the second control signal;wherein the control system receives a feedback signal from the displayand the control system generates the second control signal in responseto the feedback signal from the display.
 20. A robotic catheterprocedure system according to claim 19, wherein the feedback signalindicates that the at least one image has been displayed.